Prepared And Reported By: Dr. Najah Mohmed Osman

This is a case report of a 3-month-old orphan girl from Shaaxid district, Burao, Somaliland, admitted to Burao General Hospital with severe acute malnutrition (SAM), complicated by various health issues

Key Points:

• Background:
  • Orphan (mother died early postpartum period).
  • From a rural area with a low socio-economic background.
  • No breastfeeding history.
  • No vaccination records.
• Initial Presentation:
  • Catastrophically wasted, apathetic.
  • Cough, vomiting, diarrhea, poor feeding.
  • Left eye purulent discharge and corneal opacity.
  • Weight: 2.4kg (very low for age).
  • Length: 50cm (possibly stunted growth).
  • WHO Z-score: <-4 (severely malnourished).
  • Chest exam: bilateral crackles, tachypnea, tachycardia.
  • Abdominal exam: soft, no masses, bowel sounds hyperactive
• Initial Diagnosis:
  • SAM.
  • Severe pneumonia.
• Initial Treatment:
  • Antibiotics (intravenous).
  • Therapeutic feeding (F100).
  • Vital sign monitoring.
  • Ophthalmology referral (revealed congenital glaucoma and gonorrheal conjunctivitis) with appropriate eye medication prescribed.
• Complications:
  • After a week: recurrent cough, shortness of breath, poor feeding, abdominal distension, altered consciousness.
  • Investigations repeated:
    • Complete blood count (CBC) is suggestive of severe infection (possibly
    • sepsis).
    • Stool analysis: excessive bacteria again.
    • Chest X-ray: bilateral hilar opacity (abnormalities in the lung regions).
  • Diagnosed with sepsis, electrolyte imbalances, and bilateral hilar opacity (chest X-ray).
  • Positive pulmonary TB test.
• Further Treatment:
  • Stronger antibiotics.
  • Electrolyte supplementation.
  • Oxygen therapy.
  • Nasogastric tube feeding.
  • Anti-tuberculosis treatment (ATT).
• Outcomes:
  • Gradual improvement after 2 weeks.
  • Became oxygen-independent.
  • Improved cough, feeding, and weight gain (3.4kg).
  • Eye discharge cleared, but corneal opacity remained.
• Discharge Plan:
  • Ongoing ATT medication.
  • Ophthalmology follow-up.
  • Vaccinations.
  • Nutritional consultation (no MCH services in Shaaxid).

Appreciation:

I would like to acknowledge the collaborative effort of the stabilization center team, Burao General Hospital, the Ministry of Health Development, UNICEF, and ANPPCAN in providing care for this child.

This is a positive story of successful intervention in a complex case of malnutrition and multiple health complications.

Dr. Mahdi Abdullahi Liban.